超声评估妊娠糖尿病患者顺产后肛提肌裂孔形态改变

Ultrasonography for evaluating morphological changes of levator hiatus in patients with gestational diabetes mellitus after spontaneous delivery

目的采用超声检查评估妊娠糖尿病(GDM)患者顺产后肛提肌裂孔形态改变。方法前瞻性纳入302名孕早期(6~8周)孕妇,分别于孕早期、产后12周、6个月及1年以超声测量静息态(静息期)、缩肛状态(收缩期)及瓦尔萨尔瓦动作(张力期)下盆底肌裂孔指标。于孕28周测量血糖据以诊断GDM并将纳入孕妇分为GDM组及非GDM组;比较GDM组与非GDM组间超声指标及产后盆底肌张力分级,采用Spearman相关性分析评价GDM组盆底肌张力分级与肛提肌裂孔指标的相关性。结果共纳入153名受试者,包括51例GDM及102名非GDM。2组产后12周不同状态下肛提肌裂孔横径(LH-TD)、肛提肌裂孔前后径(LH-APD)、肛提肌裂孔面积(LHA)均高于孕早期(P均<0.05)。产后6个月及1年,GDM组收缩期LH-APD、LHA及张力期LH-TD、LH-APD、LHA均高于孕早期(P均<0.05),非GDM组张力期LH-APD、LHA均高于孕早期(P均<0.05)。产后1年GDM组收缩期LH-APD、LHA及张力期LH-TD、LHA均高于非GDM组(P均<0.05),盆底肌张力Ⅱ~Ⅲ级比例高于、而Ⅳ~Ⅴ级比例低于非GDM组(P<0.05)。产后1年GDM组盆底肌张力分级与静息期、收缩期、张力期LH-TD、LH-APD、LHA均呈负相关(P均<0.05)。结论GDM患者顺产后肛提肌裂孔形态变化较大,需早期开展康复训练。

Objective To observe the morphological changes of levator hiatus in patients with gestational diabetes mellitus(GDM)after spontaneous delivery with ultrasonography.Methods A total of 302 pregnant women in the first trimester(6—8 weeks)were prospectively observed,and the parameters of pelvic floor muscle hiatus were measured with ultrasound during the first trimester,also 12 weeks,6 months and 1 year after delivery at resting-state(resting period),anal contraction state(systole period)and Valsalva maneuver(tension period),respectively.Blood glucose was measured at 28 weeks of gestation,GDM was diagnosed,and the pregnant women enrolled were divided into GDM group and non-GDM group.The ultrasonic parameters and postpartum pelvic floor muscle tension were compared between groups.Spearman correlation analysis was used to evaluate the correlations of pelvic floor muscle tension grade and anal levator hiatus parameters in GDM group.Results Totally 153 pregnant women were enrolled and assigned into GDM group(n=51)and non-GDM group(n=102).Transversal diameter of levator hiatus(LH-TD),anteroposterior diameter of levator hiatus(LH-APD)and levator hiatus area(LHA)in different periods 12 weeks postpartum in both groups were higher than those in early pregnancy(all P<0.05).Six months and 1 year postpartum,in GDM group,LH-APD and LHA in systole period,also LH-TD,LH-APD and LHA in tension period were higher than those in early pregnancy(all P<0.05),while in non-GDM group,LH-APD and LHA in tension period were higher than those of early pregnancy(all P<0.05).One year after delivery,LH-APD and LHA in systolic period,as well as LH-TD and LHA in tension period in GDM group were all higher than those in non-GDM group(all P<0.05),whereas the proportion of pelvic floor muscle tension of gradeⅡ—Ⅲwas higher,of gradeⅣ—Ⅴwas lower in GDM group than those in non-GDM group(P<0.05).One year after delivery,pelvic floor muscle tone grade in GDM group was negatively correlated with LH-TD,LH-APD and LHA in resting,systole and tension period(all P<0.05).Conclusion The morphology of levator hiatus changed greatly in GDM patients after spontaneous delivery,and rehabilitation training should be carried out early.